Hpb最新文献

Background: Hepatitis C virus (HCV)-discordant liver transplants (LT), nonviremic and viremic, were first shown at our center as safe and efficacious for HCV-negative recipients in the short-term. This review evaluates HCV-discordant LT long-term outcomes.

Methods: All HCV-discordant deceased donor LT from 03/2016-06/2023 were reviewed in this retrospective, single-center study.

Results: 194 HCV-discordant LTs (96 (49.5 %) nucleic acid test (NAT)-negative and 98 (50.5 %) NAT-positive) were evaluated with a median follow-up of 53 months. Baseline liver biopsies of 139 (71.6 %) allografts, report 47 (24.2 %) no fibrosis, 27 (13.9 %) stage 1 fibrosis, and 65 (33.5 %) stage 2 fibrosis. Stage 2 fibrosis was higher among NAT-positive allografts (46.9 % vs. 19.8 %). Seven (6.3 %) NAT-negative allograft recipients experienced HCV transmission. One (1.1 %) NAT-positive allograft recipient experienced early HCV relapse, requiring additional treatment. All treated recipients achieved sustained viral response (SVR). There was no difference in patient or graft survival by allograft NAT status or fibrosis stage.

Conclusion: This is first report to show HCV-discordant LT exhibit low rates of relapse, achieve long-term SVR and have similar patient and graft survival regardless of allograft HCV viremia or fibrosis; thus, justifying their use for transplantation in the long-term.

Background: The optimal timing of laparoscopic cholecystectomy (LC) in mild acute biliary pancreatitis (MABP) remains debated. This study compared early (within 72 h) versus delayed LC outcomes.

Methods: A randomized trial at Zhejiang Hospital assigned 120 MABP patients to early or delayed LC. Demographics, complications, operative outcomes, and hospital stay were analyzed.

Results: There were no differences in baseline demographics, overall complication rates (10 % vs. 8.3 %; P = 0.752), intraoperative blood loss (33.93 ± 17.68 mL vs. 37.08 ± 30.97 mL; P = 0.593) or conversion to open surgery rate (3.3 % vs. 5.0 %; P = 1.00) between the two groups. There were no recurrent biliary events, postoperative readmissions, reoperations, or deaths in either group; However, the early LC group demonstrated significant advantages in intraoperative adhesions (80 % vs. 93.3 %; P < 0.05), procedure time (61.87 ± 12.54 vs. 66.77 ± 12.11 min, P < 0.05) and the length of hospital stay (5 days vs. 7 days, P < 0.05).

Conclusion: For patients with MABP, early LC performed within 72 h of admission significantly reduces hospital length of stay and procedure time, without increasing perioperative complication rates or measures of procedural difficulty.

Background: Solitary colorectal liver metastasis (SCRLM) exhibits substantial heterogeneity in recurrence patterns after hepatic resection, yet individualized prediction tools for recurrence-free survival (RFS) are lacking.

Methods: In this multicenter retrospective study, 698 SCRLM patients undergoing hepatic resection were analyzed (training cohort: n=574; validation cohort: n=124). RFS was the primary endpoint. Three predictive models-random survival forest (RSF), Gradient Boosting Machine (GBM), and eXtreme Gradient Boosting (XGBoost)-were developed and compared. Model performance was assessed via concordance index (C-index), time-dependent area under the ROC curve (AUROC), and calibration plots.

Results: The XGBoost model achieved the best performance, with AUROCs of 0.93 and 0.87 at 1 year, and 0.89 and 0.86 at 3 years, in the training and validation cohorts, respectively. Compared with the modified Clinical Score (m-CS), the model demonstrated significantly higher discrimination at 1, 2, and 3 years (all P < 0.001), and also identified a subgroup of patients more likely to benefit from postoperative chemotherapy. A user-friendly online tool was developed for clinical application: https://scrlm.shinyapps.io/scrlmapp/.

Conclusion: We developed and validated a machine learning-based model for SCRLM, enabling individualized recurrence risk prediction and guiding postoperative chemotherapy decisions. This approach may improve outcomes while reducing overtreatment.

Background: Intraoperative localization of pancreatic neuroendocrine tumors (pNETs) is challenging, particularly for small lesions during minimally invasive surgery due to the lack of tactile feedback. Indocyanine green (ICG) fluorescence imaging is a promising technique to enhance tumor visualization and surgical guidance. This systematic review evaluates current evidence on ICG use in pNET surgery, focusing on indications, timing, dosage, and intraoperative strategies.

Methods: A systematic search of PubMed, Embase, and Web of Science was conducted up to May 2025, following PRISMA guidelines. Included studies reported intraoperative ICG use in pNET surgery. Preclinical studies, non-English articles, and those lacking data on ICG protocol or dosage were excluded.

Results: Fifteen studies involving 43 patients were included. Diagnoses were insulinoma (39.5 %), unspecified pNETs (58.2 %), and one case of neuroendocrine hyperplasia. ICG identified tumors in 88.4 % of cases, with a positive predictive value of 95.0 %. ICG was mostly administered intravenously after pancreatic exposure, with doses ranging from 1 to 25 mg. Fluorescence appeared within 5 min and was homogeneous in 97.4 % of cases. No adverse events were reported.

Discussion: ICG fluorescence is a safe and effective tool for localizing pNETs. Further studies are needed to standardize protocols and optimize clinical use.

Background: Few population-based studies exist for gallbladder cancer (GBC). This study explored incidence, diagnostics, treatment, and survival of patients with GBC in a national cohort.

Methods: Patients with GBC during 2006-2019 in Finland were included from Finnish Cancer Registry with manual patient data verification.

Results: GBC was diagnosed in 1183 patients. Overall incidence was 1.56:100,000 and it decreased over time (from 1.81 to 1.35, p < 0.001). For detailed analysis, 1016 patients were included. The proportion of patients with T2-T3 increased (from 46 % to 65 %; p < 0.001) and T4 decreased (from 35 % to 18 %; p < 0.001). Similarly, the proportion of patients with stage IVA decreased (from 10 % to 4 %, p = 0.002) and stage II increased (from 12 % to 20 %, p = 0.006). In total, 185 (18 %) patients underwent curative-intent surgery with a 92 % R0 resection rate. The proportion of curative-intent surgery increased (from 15 % to 23 %, p = 0.013), as well as use of adjuvant (from 19 % to 54 %, p < 0.001) and systemic chemotherapy (from 31.4 % to 42.1 %, p = 0.014). Median overall survival was 7 months and 5-year overall survival 14 %, which improved during the study period (from 12 % to 14 %, p = 0.007).

Conclusion: The incidence of GBC decreased, and overall survival improved, likely due to increased surgical and oncological treatments.

Background: Patients with gallbladder polyps (GPs) are frequently subject to surveillance or cholecystectomy due to a risk of malignancy. As most GPs prove to be benign, potential overtreatment may impact quality of life (QoL). This study aimed to evaluate QoL in patients with GPs, compare it to the general population, and identify factors associated with QoL.

Methods: Patients diagnosed with GPs were included from 26 Dutch centres from 2018 to 2020, and followed until 2024. QoL was assessed at multiple time points using generic (EQ-5D) and disease-specific (GIQLI) instruments. Demographics, imaging, and surgical data were analysed.

Results: Among 207 patients, 42 (20.3 %) underwent cholecystectomy; neoplastic polyps were found in 3 (1.4 %). Overall, baseline EQ-5D scores were similar to the general population (0.85 vs 0.87; p = 0.20), while GIQLI scores were lower (116.1 vs 122.6; p < 0.001). Anxiety was reported by 39 % and was the strongest predictor of reduced QoL (EQ-5D: β = -0.095; GIQLI: β = -15.49; p < 0.001). QoL was not associated with GP characteristics.

Conclusion: GPs are associated with reduced QoL, driven predominantly by anxiety. Structured counselling on low malignancy risk and less intensive surveillance may alleviate anxiety and reduce overtreatment.

Background: Staging laparoscopy (SL) is performed to detect occult metastases in patients with localized pancreatic cancer. However, current guideline recommendations vary widely on routinely performing SL. This global survey investigated use and indications of SL.

Methods: An online survey was sent to members of nine international societies and working groups. Information was obtained about SL use, indications SL and adjunct diagnostic modalities across four clinical scenarios.

Results: Among 617 responding surgeons (76 countries, six continents), 82% used SL which varied between regions (Americas 90%, Asia 85%, Oceania 81%, Europe 76%, Africa 59%; P < 0.050). Most perform SL during the same session as the scheduled laparotomy (63-79%). A SL was mainly performed at the time of upfront surgery (71%), after (60%) or before (37%) neoadjuvant/induction therapy, and before radiotherapy (31%). SL was mainly performed in selected patients, either based on indeterminate/suspicious lesions on cross-sectional imaging (78-87%), resectability status (54-64%), and/or elevated CA19-9 level (60-69%). Most common used adjuncts were cytological lavage (37-55%) and intra-abdominal liver ultrasonography (36-50%).

Conclusion: Despite considerable global variability, SL is widely used to detect occult metastases in pancreatic cancer, mainly in high-risk patients and often during the scheduled laparotomy. The observed variability highlights the need for more evidence leading to stronger guideline recommendations.

Aims: We conducted this systematic review to answer the questions: a. what are the timing categories for revision surgery (RS) in incidental gallbladder cancer (iGBC)? b. which RS timing achieves better oncological outcomes?

Methods: We performed literature search in 4 databases (PubMed, Scopus, Google Scholar and Cochrane Reviews) till 10th October 2025 and included studies which reported patient outcomes based on RS timing. Study characteristics, timing category definitions and RS outcomes were collected. (Study protocol PROSPERO ID CRD42023453990).

Results: Twelve retrospective studies were included, with 2067 iGBC patients (566 males and 1346 females). On the 'Joanna Briggs Institute' (JBI) tool, most studies scored a 'Yes' to 7-8 out of 10 questions. There was no consensus on the definitions of 'early', 'intermediate' and 'delayed' timings for RS. Successful RS, perioperative morbidity, R0 resection were similar. On individual patient data meta-analysis, there was no difference in overall survival between RS at '4 weeks' [hazard ratio: 1.29, 95 % CI: 0.79-2.10].

Conclusion: There was no consensus on the definitions of timing categories and optimum timing for RS in iGBC. Definitions of timing categories need to be standardised and future studies based on these categories may identify the ideal timing of RS in iGBC.

Background: Although biliary brush cytology has a high specificity (95-100 %), the sensitivity is poor (41-67 %). This study aimed to evaluate whether the use of an optimized protocol for brush cytology improves the results in patients with suspected perihilar or intrahepatic cholangiocarcinoma (pCCA/iCCA).

Methods: Patients were prospectively included after changing the protocol (June 2021-June 2023) and compared with a historical cohort (January 2017-May 2021). Changes included different brush processing, addition of next-generation sequencing (NGS), and additional sampling (two brush samples and intraductal biopsies). Primary outcome was the sensitivity and the specificity of the procedure.

Results: A total of 175 patients were evaluated (62 prospective, 113 historical) of which 165 patients had malignant disease (94 %). After implementation of the protocol, the sensitivity was 88.3 % (95%CI, 76.8-94.8 %) versus 50.5 % (95%CI, 40.6-60.3 %) prior to implementation. Sensitivity of only the first brush sample with the optimized processing did also significantly increase (78 %; 95%CI, 65.5-87.5 %). Specificity was 100 % in both groups (2/2 vs 8/8).

Conclusions: A modification in the processing of cytopathology led to a significant improvement in the sensitivity of the first bile duct brush to 78 %. Furthermore, adding NGS increased sensitivity to 83 %, an extra brush sample to 85 %, and intraductal biopsies to 88 %.